Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

Poole, Danielle; Liao, Shirley; Larson, Elysia; Hedt‐Gauthier, Bethany; Raymond, Nathaniel A.; Bärnighausen, Till; Fawzi, Mary C. Smith

doi:10.1186/s12991-020-0259-x

Cited by 14 publications

(21 citation statements)

References 42 publications

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“…It has been validated in the Peruvian population [ 19 , 20 ] and has been used in the national Demographic Health Survey (DHS) in Peru since 2014. Sequential testing, presenting participants, who scored at least 2 points in the PHQ-2, the other seven questions of the PHQ-9 has reported being pragmatic, preserving classification accuracy, and reducing response burden [ 21 – 23 ]. We used the Spanish version of both tools, PHQ-9 and WASSS, from the Peruvian DHS and the WHO official publication, respectively.…”

Section: Methodsmentioning

confidence: 99%

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic

et al. 2021

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Background Population health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic. Methods Cross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th–16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14. Results A total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity. Conclusions An increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.

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Section: Methodsmentioning

confidence: 99%

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic

et al. 2021

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“…Symptoms of depression were assessed in two phases using sequential methodology, which included administering the PHQ-2 followed by the PHQ-9 for those who screen positive on the former. This method has been widely used and is especially recommended for efficient data collection in conflict settings such as informal tented settlements [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon

et al. 2021

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Background Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria’s neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates. Methods A cross-sectional survey design was conducted as part of a collaborative project-“Sijilli”- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants’ sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). Results A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13–2.30), a woman (OR 1.34, 95% CI 1.06–1.70), widowed (OR 2.88, 95% CI 1.31–6.32), reporting a neurological (OR 1.73, 95% CI 1.15–2.60) or a mental health condition (OR 3.98, 95% CI 1.76–8.97) are major risk factors for depression. Conclusion Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.

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“…Evidence of the burden of depressive symptoms during the transit phase of migration in the context of protracted asylum procedures was disseminated to operational and academic stakeholders alike. The results were communicated to IOM camp management and headquarters, in a publicly available report [ 34 ], conference proceedings [ 35 , 36 ], and in peer-reviewed journal articles [ 18 , 37 ]. The translation of the study results into practice included a performance evaluation of the previously validated mental health instruments in a sequential screening approach for the classification of MDD, which preserved classification accuracy while reducing the participant response burden [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

A combination sampling approach for epidemiologic research in humanitarian settings: a case analysis of a study of depressive disorder prevalence among refugees in Greece

et al. 2021

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Background Understanding the burden of common mental health disorders, such as depressive disorder, is the first step in strengthening prevention and treatment in humanitarian emergencies. However, simple random sampling methods may lead to a high risk of coercion in settings characterized by a lack of distinction between researchers and aid organizations, mistrust, privacy concerns, and the overarching power differential between researchers and populations affected by crises. This case analysis describes a sampling approach developed for a survey study of depressive disorder in a Syrian refugee camp in Greece (n = 135). Discussion Syrian refugees face an extraordinarily high burden of depressive disorder during the asylum process (43%), necessitating population screening, prevention, and treatment. In order to preserve the informed consent process in this refugee camp setting, the research team developed a two-phase sampling strategy using a map depicting the geographical layout of the housing units within the camp. In the first phase, camp management announced a research study was being undertaken and individuals were invited to volunteer to participate. The participants’ container (housing) numbers were recorded on the map, but were not linked to the survey data. Then, in the second phase, the camp map was used for complementary sampling to reach a sample sufficient for statistical analysis. As a result of the two phases of the sampling exercise, all eligible adults from half the containers in each block were recruited, producing a systematic, age- and sex-representative sample. Conclusions Combining sampling procedures in humanitarian emergencies can reduce the risk of coerced consent and bias by allowing participants to approach researchers in the first phase, with a second phase of sampling conducted to recruit a systematic sample. This case analysis illuminates the feasibility of a two-phase sampling approach for drawing a quasi-random, representative sample in a refugee camp setting.

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Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

Cited by 14 publications

References 42 publications

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic

Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon

A combination sampling approach for epidemiologic research in humanitarian settings: a case analysis of a study of depressive disorder prevalence among refugees in Greece

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